Bowel Elimination Flashcards
What is an Hypoactive bowel?
Less than 5 per minute, must listen for 5 minutes Someone must verify
True or False: Does the stomach secretes HCL, Mucus, pepsin, and intrinsic factor (needed for vitamin B12 absorption)?
True
Dilated, engorged veins in the lining of the rectum?
Hemorrhoids
What is the action, advantage, caution of diphenoxylate and atropine?
● ACTION: Slows motility through local effect on GI wall. ● ADVANTAGES: Effective. ● CAUTIONS: Chemically related to morphin. Atropine added to prevent addiction but high in doses can be addictive. May cause dorwsiness.
What is the process for Stool Collection test?
● medical aseptic technique is imperative. ● hand hygiene, before and after glove use is essential. ● wear disposable gloves. ● do not contaminate outside of container with stool. ● obtain stool and package, label, and transport according to agency policy.
Which Peristalsis occurs every 3-12 minutes
Segmentation
Inability to control passage of feces and gas from anus.
fecal incontinence?
Breaks down fatty acid, glycerol, and alcohol
Lipase
What is Bowel incontinence?
State in which a person experiences a change in normal bowel habits characterized by INVOLUNTARY PASSAGE OF STOOL.
What is considered to be normal bowel pattern?
● individualized 1/day to 2-3 day. ● influenced by what’s eaten. High cellulose (fiber) more stool produced. ● many individuals defecate after breakfast due to mass peristalsis.
What is a hypertonic enema?
Draws fluid from colon mucosa. Increases peristalsis. Stimulates defecation reflex.
Surgical removal or resection of the large intestine?
Colostomy
State in which a person experiences a change in normal bowel habits characterized by INVOLUNTARY PASSAGE OF STOOL.
Bowel incontinence
What does the Pyloric Sphincter control?
The release of chyme from stomach to small intestine via peristalsis
What are the 2 sphincters in the anus
Internal = involuntary External = voluntary
What are the benefits oral laxatives?
● easy to administer, gradual effect, less side effects.
Normal fecal matter consist of what characteristics?
● water 75%, solids 25%. ● color. ● soft: formed consistency. ● cylindrical: 1inch and 100-300g/day. ● odor. ● Consistency
What is the action, advantage, caution of imodium?
● ACTION: Inhibits peristalsis via direct effect on GI wall muscles. ● ADVANTAGES: Not addictive, longer duration than lomotil. ● CAUTION: Must be discharged if not effective in 48 hours with acute cases.
What is the primary where bowel elimination takes place?
Large instestine
Bile does what?
a bitter greenish-brown alkaline fluid that aids digestion and is secreted by the liver and stored in the gallbladder.
How can you collect pinworms?
● collect first thing in the morning. No stool or urine. ● primary symptom: perianal itching. ● needs to be completed on consecutive days.
Rectum and sigmoid colon. patient may receive conscious sedation. outpatient procedure.
Sigmoidoscopy
Who age group of people typically abuse laxatives?
Elderly
Having a pink to red to black stool is associated with what?
Aspirin, anticoagulants
What is the cause of odor from stool?
bacteria decomposition of protein= pungent, influenced by food eaten.
glycerin base, melt and absorbed into system. patient may administer by self.
Suppositories
Miralax is bulk forming, osmotic, lubricant, oil, osmotic?
Osmotic
What is the primary purpose of the large intestine?
Absorption of water, protection, secretion and elimination of stool
What preparation is needed to perform a Barium enema the day before?
Usually. ● clear liquid diet diet day before. ● 2pm bottle of magnesium citrate or x-prep golytly. Over 4 hours. ● 7pm dulcolax tablets. ● NPO after midnight.
A hollow muscular tube where food pass to the stomach?
Esophagus
When should an toddler be able to voluntarily control defection?
30 months
Protease
an enzyme that breaks down proteins and peptides.
an enzyme that breaks down proteins and peptides.
Protease
What is the action, advantage, caution of miralax?
● ACTION: draws water into the intestine, resulting in a softer stool and more frequent bowel movements. ● ADVANTAGES: is used when rapid cleansing is desired. ● CAUTION: May cause floating and or diarrhea. Can produce dehydration. Not recommended for patients with kidney problems.
True or False: Stool sampling for testing can be sent to lab 24 hours after defecation?
False. Needs to be sent immediately for testing. must be warm.
A nurse is performing colostomy care. What does colostomy care consist of?
patient as free of odors as possible. Empty the appliance frequently. ● inspect the patients stoma regularly. ● note the size, which should stabilize within 6 to 8 weeks. ● keep the skin around the stoma site clean and dry. ● measure the patients fluid intake and output. ● explain each aspect of care to the patient and self care role. ● encourage patient to care for and look at ostomy.
What process involves involuntary and voluntary control?
Rectum-Anus
Mastication is the process of what?
Chewing, is the process by which food is crushed and ground by teeth
What foods are associated with specific effects on bowel elimination?
● constipating foods: chees, lean meat, eggs, pasta. ● laxative effect: certain fruits and vegs: prunes, bran, chocolate, spicy foods, alcohol and coffee. ● gas producing foods: onions, cabbage, beans, cauliflower, turkey
When should you palpate the painful area?
Palpate at end of assessment
Nutrients such as electrolytes are absorbed where?
Duodenum and Jejunum
Esophagus
A hollow muscular tube where food pass to the stomach
What are the patient guidelines for stool collection?
● void first so that urine is not in stool sample. ● defecate into the container rather than toilet bowl. ● do not place toilet tissue in the bed pan or specimen container. ● notify nurse when specimen is available.
Where does the absorption of water occur?
Large intestine
What is needed for a toddler to be able to voluntarily be able to control defecation?
myelinozation of sacral spinal core 18-24 monts, needed for control. cue=walking.
Hyper active bowel is what?
Continous or 5 secs or less or 35 sounds per minute
Accumulation of gas in the intestinal tract
flatulence?
What is the action, advantage, caution of mineral oil?
● ACTION: lubricates intestinal tract, and retards colonic absorption of water, softening the stool making it easier to pass. ● ADVANTAGES: Usually effective within 8 hours. ● CAUTION: May interfere with fat soluble vitamin absorption. Can be aspirated, possibly resulting in a lipid pneumonia.
During fecal diversion consistency of stool is different for each section. What is the difference in stool and location?
● ascending colon= liquid loss of electrolytes. ● transverse colon= mushy; semi solid. ● descending colon (becomes storage)= more water removed: solid. ● illeocecal valve= liquid diarrhea.
What is the next process of transferring chyme from the stomach to where?
Small intestine
What factors affect bowel elimination?
● normal bowel pattern. ● food and fluid. ● foods associated with specific effects on bowel elimination. ● food and fluid intake. ● activity and exercise. ● body position. ● ignoring urge to defecate. ● lifestyle.
Is Metamucil bulk forming, lubricant, stool softener?
Bulk forming
Normal route altered. Manipulate the bowel. temporary or permanent colostomy. no need for all or part of the bowel. proximal segment to the removed area forms the stoma.
Fecal diversion?
Chemical substances that act to facilitate passage of bowel contents.
Laxatives
Lipase is what?
Breaks down fatty acid, glycerol, and alcohol
Having a brown stool is influenced by what?
● Bilirubin to stercobilin by intestinal bacteria. ● food: dairy = light brown. ● green leafy vegetables; spinach= almost black.
True or False: Colon secretion consist of acidic mucus solution.
False: The colon secretion of mucous is alkaline.
Vitamins, iron, fluid and bile salts are nutrients mainly absorbed where?
ileum
What does a Barium enema do?
Fill cavity to see structure. ● visualizes the colon, distal small bowel and appendix. ● series of x-ray films taken after barium is instilled into the colon via an enema. ● may use gastrografin if possibility of perforation. ● bowel prep, must be free of stool.
What are the 3 sections of the small intestine?
Duodenum Jejunum ileum
Suppositories
● glycerin base, melt and absorbed into system. ● patient may administer by self.
What part of the large intestine has 2 sphincters?
Anus
Having a sedentary life does what for your bowel movement?
Constipation
Hemorrhoids are located where?
External (clearly visible) or internal
What is sigmoidoscopy?
Rectum and sigmoid colon. ● patient may receive conscious sedation. ● outpatient procedure.
When physically assessing the patient abdomen what would you be looking for?
● four abdominal quadrants (umbilicus midline). ● contour, shape, symmetry, skin, color, scars, any masses. ● distention: drum, taut skin. (Should be soft; excess fluid or flatus) ● abdominal circumference (mark it). ● localize pain. ● pannus.
Colonoscopy examination?
Colon up to the ileal cecal. ● patient may revive sedation. ● outpatient procedure.
What is Bowel Retraining?
● long term approach to control bowel elimination. ● used for chronic constipation, incontinence, or impaction. ● neuro genie bowel. Paralysis, stroke. ● GOAL: soft consistency stool and develop stool evacuation routine.
There are 2 types of motility which takes place in the intestine. What are they?
Segmentation (Colon peristalsis) Mass peristalsis
What are 3 types of laxatives used for constipation?
Oral Suppositories enema
What are the different consistencies of stool and where can they be located at?
● ascending colon= liquid. ● transverse colon= mushy; semi-solid now. ● descending colon= more water removed: solid.
What is bearing down?
Valsalva Maneuver
Ascending colon receives approximately _______ of chime and ____________ of liquid.
● 1500ml ● 1000-8000ml
The external sphincter remains contracted until decision to defecate is made. This urge to defecate will subside and return hours later? What is this?
Voluntary control
The large intestine is broken into 3 sections what are they?
Cecum Colon Rectum
Cathartics is defined as what?
A purgative action of the bowels, action is stronger and generally produces elimination of liquid stools
True or False: A toddler can control their urine before bowel movement?
False. Toddler will have better control over bowel defecation before urination
What is fecal Impaction?
● collection of hardened feces in rectum. ● results from unresolved constipation.
what is P.O.O.P.E.R S.C.O.OP ?
P= position (sitting, upright). O= output (adequate hydration). O= offer fluids. P= privacy. E= execise. R= report results. S= size (amount). C= consistency. O= occult blood. O= odor. P= peristalsis.
How does a persons lifestyle affect bowel elimination?
● habits: interruption may lead to decreased defecation. ● stress= increase in mucus production and motility. ● Chronic stress: decrease motility. ● vacation privacy.
During infancy what color should the first stool be, and what is it often referred too?
Meconium, black stool, occurs with 28 hours
Where does digestion begin?
Mouth
What is amylase?
an enzyme, found chiefly in saliva and pancreatic fluid, that converts starch and glycogen into simple sugars.
Ignoring the urge to defecate does what to our body?
● voluntary control may suppress defecation reflex. ● stool remains in rectum, water reabsorbed =hard pebble stool. ● if frequent, urge to defecate weakens= stimulants to defecate. ● pain: hemorrhoids. ● analysis fissure.
What is fecal incontinence?
Inability to control passage of feces and gas from anus.
Do you need an Order for Removal of Fecal Impaction?
Yes order is required from MD?
What organ is located in the upper right quadrant of the abdomen?
Stomach
Chyme enters the illeocecal valve to what part of the large intestine?
Cecum ( Ascending colon)
Breakdown of nutrients via mechanical take place where
Mouth
Storage of Feces?
Rectum
Where is food temporarily stored and broken down?
Stomach
What is the action, advantage, caution of colace?
● ACTION: Agents with detergent activity that allows water to penetrated and lubricate the stool. ● ADVANTAGES: recommended for those who must avoid straining. Patients on bedrest/immobile. ● CAUTION: Has lubricant component of drug that may interfere with absorption of certain vitamins.
What are 3 types of endoscopic examination
● sigmoidoscopy. ● colonoscopy. ● ephagogastroduodenoscopy
Being constipated and producing black stool is associated with what?
Iron Salts
This valve prevents digested food from entering the small intestine but allow food to enter the large intestine?
Ileocecal valve
The rectum is connected to what?
Sigmoid colon
What consist of indigestible food and provides bulk?
Ascending colon
How long should you listen to bowel movement sounds?
5 mins
What is the action, advantage, caution of Duculax?
● ACTION: Drug promotes peristaltic by irritating the intestinal mucosa or stimulating nerve endings in intestinal wall. ● ADVANTAGES: Works more quickly than bulking agents. ● CAUTION: Are the most abused laxatives on the market. Causes lazy bowel syndrome, may affect absorption of vitamin D and calcium
What are the different physical characteristics of the abdomen?
● Normal: Convex or flat, symmetric. ● Abnormal: Hollow or scaphoids: distended, asymetric.
sitting during defection increases pressure?
Downward rectal pressure
Breast fed infant would have what color stool?
Yellow-golden and loose stool, more frequently
What extends from the ileocecal valve to the anus?
Large intestine
Distension is defined as?
● accumulation of excessive amounts of flats or liquid or solid intestinal contents. ● abdominal fullness, discomfort, inability to pass flatus. ● abdomen may be slightly distended to rigid.
What provides lubrication for food to flow through the small and large intestine?
Secretion of alkaline mucus
What are the 5 structures of the large intestine?
Ascending colon Transverse colon descending colon sigmoid colon rectum Anus
layer of fat covered by skin on the anterior abdominal wall of obese or formerly obese patients.
Pannus?
Pregnancy affects bowel elimination how?
● hormone changes= decrease muscle tone= constipation. ● infant position. ● iron supplements.
What are the measurements of the small intestine?
1in in diameter and 20 feet long
Majority of absorption of nutrients occur where?
Small intestine
Having a green-grayish tinge in stool along with C.Diff and diarrhea is in relation to what?
Antibiotics
What are the uses for Laxatives and cathartics?
● reduce cholesterol. ● obtain stool sample. ● accelerate excretion of parasites after anthelminthics (antiparasitic drug) started. ● accelerate elimination of potentially toxic substances (kayexalate). ● pre op or pre procedure. ● prevent straining at stool w/ CAD, hemorrhoids. ● relieve constipation in pregnancy, in the elderly. In children with megacolon, and in those with decreased motility.
What is fecal diversion?
● Normal route altered. Manipulate the bowel. ● temporary or permanent colostomy. ● no need for all or part of the bowel. ● proximal segment to the removed area forms the stoma.
What part of the large intestine allows for defecation of bowel?
Anus
Where does the salivary secretion of enzymes take place?
Mouth
Thigh Flexion does what during defection
Increases abdominal pressure
Where is Chyme located at?
Stomach
How does the autonomic NS affect the rate of peristalsis?●
● sympathetic slows peristalsis. ● parasympathetic increases peristalsis and emptying.
Contraction and relaxation of smooth muscles via esophagus and intestine is referred to as?
Peristalsis
While auscultating a patient what would you note in your finding?
Listen for bowel sounds in all quadrants. ● note frequency and character, audible clicks, and flatus. ● describe bowel sounds as hypoactive, hyperactive, absent or infrequent.
How will antacids affect stool color and consistency?
White or speckling in stool Constipation or diarrhea
What is constipation?
● infrequent sometimes painful passage of hard, dry stool. ● stool moves slowly through the large intestine. ● or remains in large intestine too long. ● defined in relation to persons normal defecation pattern. ● more of a symptom than a disorder.
When 1500ml of chime and 1000-8000ml of liquid is absorbed it turns into
Stool
What is a endoscopic examination?
● Visualization or the internal structures of the GI tract via a fiber optic scope. ● used for visualization, biopsy, polyp removal, cauterize, bleeding vessels.
What is flatulence?
Accumulation of gas in the intestinal tract
What is the action, advantage, caution of Bismuth subsalicylate (pep-bismal)?
● ACTION: Absorbs and soothes. ● ADVANTAGES: No drowsiness. ● CAUTION: May interfere with absorption of other medications and nutrients.
What is a hem occult test, and where should it be performed?
may be done on unit instruct client to refrain (1-3 days) from 2 different parts of stool
What is the action, advantage, caution of paregoric?
● CATEGORY: Acts on GI smooth muscle. ● ACTION: Increase smooth muscle tone. Decrease GI motility. Diminishes GI secretion. ● ADVANTAGES: Effective. ● CAUTIONS: May be addictive, morphine component. May cause light headedness and drowsiness. Discontinue as soon as possible.
Powerful muscle contractions, move over large area, propel food through the small and large intestines especially after eating.
Mass peristalsis
How long is the rectum?
Varies based on age
How often should a infant defecate?
After every meal
What are some type of therapeutics for better bowel elimination?
Laxatives, stool softeners, enemas
This occurs 1-4 times a day, and only 1/3-1/2 of indigested food is excreted in 24 hours, and the rest 28-72 hours?
Mass peristalsis
What does antidiarrheal agents do?
● act to slow motility or absorb excess fluid into the bowel. ● absorbants and bulk forming agents change the consistency of the stool. ● cure the underlying cause- antibiotics.
Absent bowel sounds beyond 72 hours post op
Paralytic ileus
Laxatives is what?
Chemical substances that act to facilitate passage of bowel contents.
When physically assess anus and rectum of patient. What would you be checking for?
● lesions, ulcers, fissures inflammation, and external hemorrhoids. ● ask the patient to bear down as though having a bowel movement. ●appearance of internal hemorrhoids or fissures and fecal masses. ● inspect perineal area for skin irritation secondary to diarrhea or fecal incontinence.
What is the process of performing the Valsalva Maneuver (Bearing Down)?
Deep Breathing Closed Glottis Moving diaphragm toward Contract abdominal Muscles contract pelvic floor muscles
Less than 5 per minute, must listen for 5 minutes Someone must verify
Hypoactive bowel
What is Diarrhea
State in which a person experiences a passage of loose unformed stools at least 3 LOOSE LIQUID STOOLS PER DAY; abdominal pain, cramping, hyperactive, bowel sounds; urgency.
What is one of problems that plague school-aged children for defecation?
Constipation
What is Pannus?
● layer of fat covered by skin on the anterior abdominal wall of obese or formerly obese patients.
What should a person consume daily for fluid intake?
2000-3000ml
What are some examples of Implementation?
Health promotion: ● diet. ● fluids. ● activity and exercise. ● bowel habits. ● colorectal screening.
State in which a person experiences a passage of loose unformed stools at least 3 LOOSE LIQUID STOOLS PER DAY; abdominal pain, cramping, hyperactive, bowel sounds; urgency.
Diarrhea
Surgical openings are most commonly formed in the ileum (ileostomy) or the colon (colostomy).
Osotomy
Neutralizes irritating acids from local bacteria fermentation.
Alkaline mucus
What are the measurements of the large intestine?
5-6 feet in length, 1-3in in diameter, decreases in size from cecum to anus
Continous or 5 secs or less or 35 sounds per minute
Hyper active
What vitamin is produced in the small intestine?
Vitamin K
What is an EGD (Esophagogastroduodenoscopy)?
Esophagus, stomach, duodenum. ● patient may receive conscious sedation. ● outpatient procedure.
What is the action, advantage, caution of metamucil?
● ACTION: psyllium grain or synthetic product that causes stool to absorb water and swell stimulating peristalsis. ● ADVANTAGES: usually acts withing 24 hours. ● CAUTION: may interfere with absorption of calcium and iron and certain drugs. Should not be given to bedridden patients or those with intestinal stricture.
Having an active lifestyle with daily exercising does what for the small and large intestine?
Increase peristaltic through improved muscle tone especially abdominal, diaphragm and perineum muscles.
What enzymes breaks down fats, proteins, and carbs into basic elements?
Amylase, lipase, bile, protease
Formula fed Infant stool would consist of what color?
Yellow to brown pasty stool, stronger odor than breast fed
What is an ostomy?
Surgical openings are most commonly formed in the ileum (ileostomy) or the colon (colostomy).
